Adult ICU Emergency Medication Dosing Guidelines 

ACLS Drug
Usual Dose Max Dose Comments
Medications Package
May give additional 12mg dose if no conversion.
Adenosine 6mg --- Vial Defibrillator must be present. Decrease dose to
3mg if pt on dipyridamole or carbamazepine
Amiodarone 150 mg 300 mg Vial 300mg for VFib or pulseless VT
0.04 mg/kg
Atropine 0.5 mg
(or 3 mg)
Syringe No longer recommended in asystole and PEA

Given every 3-5 minutes

Epinephrine 1 mg --- Syringe 2-2.5mg if given endotracheally
For VFib or pulseless VT, If persists after initial
3 mg/kg
Lidocaine 1-1.5 mg/kg
(or 300 mg)
Syringe dose, may give additional 0.5-0.75mg/kg every
5-10min to max dose
Vasopressin 40 units --- Vial st nd
May replace 1 or 2 dose of epinephrine
Magnesium 1-2 g 6g Vial For VFib/pulseless VT with Torsades only
RSI Drug
Usual Dose Max Dose Comments
Medications Package
0.4 mg/kg Give 50% usual dose in hemodynamic instability
Etomidate 0.2 mg/kg
(or 20 mg)
Vial or Syringe Decreases seizure threshold
0.1 mg/kg
Midazolam 0.03 mg/kg
(or 10 mg)
Vial Active metabolite is renally eliminated

Associated with dose-related hypotension

2.5 mg/kg (*give in 20 mg increments)
Propofol 1 mg/kg
(or 200 mg)
Vial Avoid in hypovolemic patients
Caution with peanut allergy (soy derivatives)
2.5 mg/kg Do not use in head injury, heart disease, or
Ketamine 1 mg/kg
(or 200 mg)
Vial hypertensive emergency patients
1.2 mg/kg Use adjusted BW if > 130% IBW
Rocuronium 1 mg/kg
(or 100 mg)
Vial (Paralysis within 60 seconds)
Use total BW for dosing (onset within 30 seconds)
2.0 mg/kg Do not use if history of malignant hyperthermia or
Succinylcholine 1.5 mg/kg
(200 mg)
Vial seizures, Caution if at risk for hyperkalemia
(muscle disorders, burn, etc)
Drug
Miscellaneous Usual Dose Max Dose Comments
Package
2 mcg/kg
Fentanyl 1 mcg/kg
(100 mcg)
Ampule For analgesia if needed with RSI/procedures

0.1 mg/kg Use adjusted BW if > 130% IBW

Vecuronium 0.1 mg/kg
(or 10 mg)
Vial Prolonged effect in renal/hepatic impairment
0.4 mg Lower doses with re-dosing (q2-3 min) may be
Naloxone 0.04 mg
(may repeat)
Vial or syringe needed in opiate-dependent patients

Standard Rate options

Drips Comments
Concentration Start Max
Cisatracurium 200mg/250mL 0.5mcg/kg/min 10mcg/kg/min Paralytic of choice in renal or hepatic insufficiency
Diltiazem 100mg/100mL 5mg/hr 15mg/hr May bolus 10-25 mg initially
Does not significantly raise blood pressure but
Dobutamine 250mg/250mL 1-5mcg/kg/min 20mcg/kg/min
used for inotropic effects
Dopamine 400mg/250mL 1-5mcg/kg/min 20mcg/kg/min Central line
Epinephrine 4mg/250mL 0.5 mcg/min 10mcg/min Central line
Esmolol 2500mg/250mL 25mcg/kg/min 300mcg/kg/min May bolus 50-500 mcg/kg initially
Contraindicated in arrhythmia and angina, caution
Isoproterenol 1mg/250mL 0.2mcg/min 20mcg/min
in heart disease
Caution if history of heart block
Lidocaine 2000mg/250mL 1-4mg/min 5mg/min
Caution in hepatic dysfunction
Milrinone 40mg/200mL 0.375mcg/kg/min 0.8mcg/kg/min Accumulates in renal failure
Nitroglycerin 25mg/250mL 5mcg/min 400mcg/min Increases ICP, caution in TBI
Cyanide toxicity risk with renal insufficiency and
Nitroprusside 50mg/250mL 0.3mcg/kg/min 10mcg/kg/min prolonged infusion
Max dose 10mcg/kg/min ≤10 min
Norepinephrine 8mg/250mL 1mcg/min 30mcg/min Central line
Phenylephrine 30mg/250mL 20mcg/min 200mcg/min Pure alpha agonist with least effect on heart rate